{$submit_form_open}

<div class="layer" xmlns="http://www.w3.org/1999/html" xmlns="http://www.w3.org/1999/html"
     xmlns="http://www.w3.org/1999/html">
    <div class="css3_content_shadow">
    {if $add_mode|@count eq 0}
        <table border="0" cellpadding="0" cellspacing="0" style="table-layout:auto;">
            <tbody>
            <tr>
                <td style="width:1px; position: absolute; top: -110px; margin-left: -150px;">
                    {$submit_form_data.add_rx_button.html}
                </td>
            </tr>
            </tbody>
        </table>
        {else}
        <div class="Utils_RecordBrowser__container">
            <table class="Utils_RecordBrowser__View_entry" cellpadding="0" cellspacing="0" border="0">
                <tr>
                    <td class="column" style="width: 25%;">
                        <table cellpadding="0" cellspacing="0" border="0" class="edit">
                            <tbody>
                            <tr>
                                <td class="label">{$submit_form_data.date.label}</td>
                                <td class="data">
                                    <div style="position:relative;">
                                        {$submit_form_data.date.html}
                                    </div>
                                </td>
                            </tr>
                            </tbody>
                        </table>
                    </td>
                    <td class="column" style="width: 25%;">&nbsp;</td>
                    <td class="column" style="width: 25%;">&nbsp;</td>
                    <td class="column" style="width: 25%;">&nbsp;</td>
                </tr>
            </table>
        </div>

        <div class="margin2px">
            <table class="Utils_GenericBrowser" cellspacing="0" cellpadding="0"
                   style="width:100%;table-layout:fixed;overflow:hidden;text-overflow:ellipsis;">
                <thead>
                <th nowrap="1" style="width: 0.5%;" class="first"><span></span></th>
                <th nowrap="1" style="width: 4%;"><span>Sphere</span></th>
                <th nowrap="1" style="width: 4%;"><span>Cylinder</span></th>
                <th nowrap="1" style="width: 6%;"><span>Axis</span></th>
                <th nowrap="1" style="width: 5%;" class="last"><span>Add</span></th>
                </thead>
                <tbody>
                <tr>
                    <td class="Utils_GenericBrowser__td ">OD</td>
                    <td class="Utils_GenericBrowser__td ">{$submit_form_data.od_sphere.html}</td>
                    <td class="Utils_GenericBrowser__td ">{$submit_form_data.od_cylinder.html}</td>
                    <td class="Utils_GenericBrowser__td ">{$submit_form_data.od_axis.html}</td>
                    <td class="Utils_GenericBrowser__td ">{$submit_form_data.od_add.html}</td>
                </tr>
                <tr>
                    <td class="Utils_GenericBrowser__td ">OS</td>
                    <td class="Utils_GenericBrowser__td ">{$submit_form_data.os_sphere.html}</td>
                    <td class="Utils_GenericBrowser__td ">{$submit_form_data.os_cylinder.html}</td>
                    <td class="Utils_GenericBrowser__td ">{$submit_form_data.os_axis.html}</td>
                    <td class="Utils_GenericBrowser__td ">{$submit_form_data.os_add.html}</td>
                </tr>
                </tbody>
            </table>
        </div>

        <div class="Utils_RecordBrowser__container">
            <table class="Utils_RecordBrowser__View_entry" cellpadding="0" cellspacing="0" border="0">
                <tr>
                    <td class="column" style="width: 25%;">
                        <table cellpadding="0" cellspacing="0" border="0" class="edit">
                            <tbody>
                            <tr>
                                <td class="label">{$submit_form_data.pd.label}</td>
                                <td class="data">
                                    <div style="position:relative;">
                                        {$submit_form_data.pd.html}
                                    </div>
                                </td>
                            </tr>
                            </tbody>
                        </table>
                    </td>
                    <td class="column" style="width: 25%;">
                        <table cellpadding="0" cellspacing="0" border="0" class="edit">
                            <tbody>
                            <tr>
                                <td class="label">{$submit_form_data.lens_type.label}</td>
                                <td class="data">
                                    <div style="position:relative;">
                                        {$submit_form_data.lens_type.html}
                                    </div>
                                </td>
                            </tr>
                            </tbody>
                        </table>
                    </td>
                    <td class="column" style="width: 25%;">
                        <table cellpadding="0" cellspacing="0" border="0" class="edit">
                            <tbody>
                            <tr>
                                <td class="label">{$submit_form_data.index.label}</td>
                                <td class="data">
                                    <div style="position:relative;">
                                        {$submit_form_data.index.html}
                                    </div>
                                </td>
                            </tr>
                            </tbody>
                        </table>
                    </td>
                    <td class="column" style="width: 25%;">
                        <table cellpadding="0" cellspacing="0" border="0" class="edit">
                            <tbody>
                            <tr>
                                <td class="label">{$submit_form_data.lens_type.label}</td>
                                <td class="data">
                                    <div style="position:relative;">
                                        {$submit_form_data.lens_type.html}
                                    </div>
                                </td>
                            </tr>
                            </tbody>
                        </table>
                    </td>
                </tr>
                <tr>
                    <td class="column" style="width: 25%; padding-bottom: 4px;">
                        <table cellpadding="0" cellspacing="0" border="0" class="edit">
                            <tbody>
                            <tr>
                                <td class="label">{$submit_form_data.odmd.label}</td>
                                <td class="data">
                                    <div style="position:relative;">
                                        {$submit_form_data.odmd.html}
                                    </div>
                                </td>
                            </tr>
                            </tbody>
                        </table>
                    </td>
                    <td class="column" style="width: 25%;">
                        <table cellpadding="0" cellspacing="0" border="0" class="edit">
                            <tbody>
                            <tr>
                                <td class="label">{$submit_form_data.license_no.label}</td>
                                <td class="data">
                                    <div style="position:relative;">
                                        {$submit_form_data.license_no.html}
                                    </div>
                                </td>
                            </tr>
                            </tbody>
                        </table>
                    </td>
                    <td class="column" style="width: 25%;">&nbsp;</td>
                    <td class="column"
                        style="width: 25%;">
                    <span style="position: absolute; padding-left: 123px; padding-top: 5px; padding-bottom: 5px;">{$submit_form_data.save_rx.html}
                    {$submit_form_data.cancel_rx.html}</span>
                    </td>
                </tr>
            </table>
        </div>
    {/if}
    </div>
</div>
{$submit_form_close}